Some who are civilly committed for addiction in Mass face abusive prison conditions. Still, some families say it’s better than the alternative
Doug and Lisa Johnston had a court order requiring that their daughter appear at a hearing to discuss her heroin addiction.
The couple had filed a petition asking for the hearing. They feared for their daughter’s life, so they planned to beg a judge to use his controversial civil commitment powers to involuntarily confine and treat their child.
But their daughter had gone “into hiding,” Doug says. And the court order expired in five days.
Although Massachusetts law requires police to help track down individuals with active civil warrants, Doug and Lisa say the police in their hometown of Stow were “not responsive” to their pleas for help. Doug got in his car, drove to Waltham where he knew his daughter often spent time, and started looking for her.
Doug and Lisa, who have asked to be identified by an alternate last name to protect their daughter’s identity, say parents in situations like theirs sometimes have to trick their children into meeting them. They’ll offer money or ask to meet up for coffee. Then they’ll call the police when their child arrives.
The Johnstons eventually found their daughter and surrendered her to court custody. From there, a judge evaluated and ultimately granted their request for commitment.
All medical beds in Massachusetts were full, however, due to a statewide demand for recovery care that has long outstripped the state’s capacities. So, the court sent Doug and Lisa’s daughter to jail at MCI Framingham.
It wasn’t the ideal result. Recent reporting by the Boston Institute for Nonprofit Journalism has included detailed documentation of abuse and harassment within that prison’s walls. When Lisa visited Framingham a few days after that court decision, she was also startled to recognize a person now living alongside her daughter—the woman had been on TV news the night before after getting arrested for allegedly committing murder.
This system, as a whole, is severely overwhelmed. As a result, national groups have rated the Commonwealth’s civil commitment apparatus one of the worst in the country. Mass is currently defending itself against multiple lawsuits alleging everything from neglect to physical abuse of civil commitment patients. Under pressure, some elected leaders are calling for reform.
Still, the Johnstons believe this process saved their daughter’s life.
Compelled by the horror of addiction and the desperation that follows repeated relapses, Bay State families filed roughly 11,000 commitment petitions in 2018 alone, according to data first accessed by WBUR. That’s a nearly 100% increase compared to data from 2010, just eight years earlier.
With their children in crisis, parents like Doug and Lisa have few options. As a result, they’re forced to struggle with the decision to commit a loved one to a system that has proven dysfunctional and morally ambiguous.
From asylums to modern wards
Modern civil commitment has roots in America’s old asylum system. Through the 1800s, wealthy patients had their families pay their way into ineffective but comfortable treatment settings, while the poor were warehoused in decrepit hospitals.
In those days, individuals received treatment at the behest of their loved ones. They had few options to choose their care, and there was little standardization determining who went into a hospital and how long they stayed there.
Things began to change in the early 1900s with the introduction of trials to decide if a person could be involuntarily committed.
By the middle of the century, psychology experts rallied for reform at the same time that antipsychotics hit the market, challenging the dominant notion that people with mental illnesses were unable to function in society.
In 1963, President John F. Kennedy signed both the Community Mental Health Centers Act and the Maternal and Child Health and Mental Retardation Planning Amendment to the Social Security Act, which effectively ended the asylum system. States across the country responded by establishing their own statutes outlining which mental illnesses could and could not land someone in the locked inpatient wards that remained.
Today, civil commitment is a checkerboard of rules and regulations, varying from state to state. Notably, while every US state allows some form of civil commitment, 13 currently exclude patients with substance use disorder from their laws.
Those that do allow substance use disorder as a valid reason for commitment vary in the burdens they take on. Illinois and Utah have statutes in place, but never use them. Places like Hawaii and Texas, meanwhile, only commit around 100 patients per year, according to a 2019 WBUR report. Others, like Florida and Massachusetts, process high numbers of involuntary civil commitments annually.
Experts and individuals fighting addiction in their own lives agree: civil commitment isn’t ideal. Still, every year, thousands of Commonwealth residents turn to it as the horrors of day-to-day addiction effectively trap them between a rock and a hard place.
“If someone has an addiction, they don’t have, in most cases, the capacity to break the cycle,” Doug says. “This breaks the cycle and gives them the opportunity to get sober and go through detox.”
Joanne Peterson, the founder of Learn to Cope, a support group for families of people battling addiction, echoes the sentiment.
She says she’s glad to have put her son through the civil commitment system in the early 2000s.
“Most people who have used it [say] it did save their son or daughter’s life,” Peterson elaborates.
Terrorist in the system
People battling serious addictions often live with any number of dangers looming overhead. In many ways, those dangers have increased over recent years.
Fentanyl, which has flooded the hard drug market, is much more powerful than straight heroin. As a result, when people overdose on it, they’re often dying long before first responders or family members can pump enough of the lifesaving drug Narcan into their system.
Doug stresses, further, that while voluntary treatment is proven to be more effective than involuntary options, families don’t have time to wait for their loved one to consent to an inpatient stay.
“The drugs are like a terrorist in their system,” Lisa says.
While not as tragic as death, parents like Doug and Lisa also worry that their children will be arrested for a drug offense.
“Either you do this through a civil process, which has no impact to the individual in terms of a court record, or you end up in the system with a criminal charge,” Doug says. “If you don’t do a civil commitment, then, eventually, you’re going to do a criminal one.”
Massachusetts police arrested 6,252 people for 10,154 total drug crimes in 2019, the last year for which data is available.
Though that continues an overall downward trend in recent years, people with addictions still fear a very real threat of prosecution. Making things worse, almost 70% of those 2019 arrests resulted in low level possession charges that people like the Johnston’s daughter could be especially susceptible to in interactions with police.
Recognizing this, many elected officials share the perspective of the Johnstons.
Frank Baker, a Boston City Council member representing parts of the South End and Dorchester, says he sees civil commitments as a viable way to address issues of rampant drug use in a part of his district sometimes referred to as “Methadone Mile.”
“If the end game is to get people off drugs … we’re not helping them by allowing them to stay on the street and to form encampments, use drugs outside and defecate on people’s steps,” he said, acknowledging complaints of many constituents frustrated about groups of people experiencing homelessness and addiction in their area.
He elaborated in a recent interview, saying, “They’ve been putting poison in their veins for five years, 10 years. They’re not really capable of making decisions right now.”
Baker has seen the civil commitment system from the inside, watching as his family petitioned courts to confine two of his siblings on different occasions more than a decade ago.
“I knew, at least, on those nights, that I could go to sleep because we knew my sibling was in a safe place,” he said.
People like Baker want to preserve, and even potentially expand civil commitments.
Defending the system, other experts and leaders further worry about the ramifications of current pushback against civil commitments. Peterson specifically says the judges who approve or deny petitions are increasingly skittish about commitments, also known as Section 35 cases. They see litigation and fear professional repercussions. That leads them to deny commitment requests they might otherwise approve.
Fentanyl or heroin use on its own is not enough to warrant a commitment in the eyes of the law, Peterson says, citing the experiences of Learn to Cope facilitators and attendees. Instead, she now tells people seeking to commit a loved one that they should try to provide evidence of the “likelihood of serious harm”—like a car crash, overdose, or accidental fire caused by someone dropping a lit cigarette.
“Taking away someone’s civil rights is not easy, so you have to have a lot of proof,” she says.
This, of course, omits a crucial fact—use of drugs like fentanyl or heroin already puts the user in serious danger.
People who overdose or crash their cars while high don’t always live to be brought before a civil court.
A broken system
Parents want their children in the kind of safe place Frank Baker describes. Often, they feel civil commitment facilities are the solution.
But as lawsuits and outside condemnation pile up, a grisly picture has emerged, suggesting that’s often not the case.
“Massachusetts is the only state that places people in prison for treatment of alcohol and substance use disorders,” one lawsuit in 2019 read. “Other states recognize what public health experts know: these disorders are medical conditions for which people need treatment, not punishment.”
The Commonwealth holds the dubious distinction of not only placing civil commitment patients in jails, but also of having some of the highest rates of civil commitments in the country. Moreover, its civil commitment system is rated one of the nation’s worst, scored with an “F” by the Treatment Advocacy Center, a nonprofit focused on fighting “legal and other barriers to the timely and effective treatment of severe mental illness.”
“You’re like, ‘Shouldn’t there be other options?’” Lisa Johnston said of jailhouse commitments, in particular.
Under the current framework, local alternatives to jail are few and far between. In 2018, of the roughly 11,000 civil commitment petitions filed in Massachusetts, courts granted just over 5,700.
The state has only 287 clinical beds, though. And an average commitment lasts at least 20 days according to a state study in 2019. That makes it impossible to keep every civilly committed person in a hospital.
While the state phased out jailhouse confinement for women in 2016, a year after the Johnstons’ daughter was committed, male overflow cases still end up in the care of either the Massachusetts Department of Correction, or the Hampden County Sheriff’s Department, which, together, offer an additional 240 beds. Advocates and experts say those jails and prisons are simply not equipped to handle drug withdrawal symptoms.
According to a 2016 Pew Research Center report, less than half of individuals incarcerated on drug charges nationwide received medication to manage symptoms. The report specifically cited jails in Massachusetts, noting that, while one facility on Cape Cod had taken common sense action to embrace a new drug with proven results, many others in the system had not.
A separate recent article by the Skywood Recovery Group zeroed in on one particular incident in Michigan, where a man lost 54 pounds in 16 days and died after a facility failed to provide him with medication to manage his opiate detox.
From the inside
Civil commitment patients themselves say they suffer abuse and neglect behind bars.
In 2017, 11 men sued the Commonwealth over their treatment while committed to a facility in Bridgewater. They had been housed at the Massachusetts Treatment Center in Bridgewater, a prison that the state itself describes as a “facility separately housing criminally sentenced male inmates identified as sex offenders and those who have been civilly committed as sexually dangerous persons.”
This facility exists expressly for the state’s most threatening sex offenders. It’s not for people committed to addiction treatment. Yet the state dumped patients there, nonetheless.
Those patients’ accusations detailed how individuals in charge of the Massachusetts Treatment Center denied them access to even Alcoholics Anonymous and Narcotics Anonymous meetings. That directly violated Department of Corrections policies mandating at least 20 hours of treatment for Section 35 patients, according to the lawsuit.
“Plaintiffs have no treatment plans and no substance use programming,” the complaint read.
Prison staff allegedly held men in their cells up to 24 hours a day.
The aforementioned sex offenders, meanwhile, lived in cells overlooking the recreation yards civilly committed patients used. They regularly, according to this complaint, yelled insults and rape threats at patients.
As those same inmates prepared the very food people on commitments ate, plaintiffs in this lawsuit said they found staples and “other substances” on their trays.
Through it all, patients allegedly wore orange DOC jumpsuits and carried identification cards falsely labeling them “inmates.”
This isn’t standard practice across civil commitment systems, if only because people committed to DOC facilities arrive without any criminal charges. They’re patients, not inmates, who are only in prison settings because of the state’s inability to find hospital beds.
“They are intimidated by the harsh conditions of confinement and do not understand why they are in prison, let alone a prison for sex offenders,” the 2017 suit said of patient attitudes.
These confinements ran long, as program administrators allegedly failed to regularly reevaluate patients for release. Instead, they kept patients in their facility for the maximum 90-day span allowed under state law. They did that even as the state struggled with its ongoing overflow problem. Even with its total of 527 clinical and correctional facility beds combined, Massachusetts can only afford to keep each patient in its system for an average of roughly 34 days before it simply runs out of space for patients.
Three of the 11 plaintiffs named in the aforementioned suit attempted suicide during their confinement, according to their their complaint.
“By confining Plaintiffs at [the Massachusetts Treatment Center], Defendants are reinforcing the perception that they are second-class citizens not worthy of receiving treatment for their disease,” the complaint read. “The entire experience is viewed by Plaintiffs as a punishment, rather than as an opportunity to begin recovery.”
A separate filing two years later alleged similar malpractice, bias, and ineffective treatment at the Massachusetts Alcohol and Substance Abuse Center (MASAC) in Plymouth, also run by the DOC. Last year, that same suit then expanded to directly attack the Hampden County civil commitment system run out of Sheriff Nick Cocchi’s jail in Ludlow. Patients who had also been incarcerated as actual inmates at that facility said they saw no difference between the actual jail and its supposed treatment wing. One said he was beaten by guards. Another said he was left to detox “cold turkey” without support and without access to the methadone he had been taking with a prescription outside of Cocchi’s facility.
Outside of civil commitment lawsuits, Boston Institute for Nonprofit Journalism reporting from July 2019 further identified a series of abuses of mentally ill inmates in the general population of the Hampden County Jail. People in crisis were getting pepper-sprayed and beaten for minor infractions.
The rate of these incidents, furthermore, was increasing.
Reached for comment, Hampden County Sheriff Nick Cocchi, who oversees civil commitment in his county jail facility, broadly denied these accusations while declining to address any specifics.
“For the families in Western Massachusetts with a loved one at a dangerous point with their addiction, we are an option of last resort,” he wrote. “But with an average stay of more than 50 days, and few people being recommitted to our program a second time, there is proof that what we are doing is working.”
The Mass DOC did not respond to requests for comment for this article.
A system making changes
Pressured in part by lawsuits, the state has made some changes.
Cocchi’s facility in Hampden County is a jail. It’s controversial. But it also represents an attempt at progress. Unlike the Massachusetts Treatment Center, Hampden County Jail does not put its patients in inmate jumpsuits.
Cocchi announced the effort in July 2018. With close to a hundred beds between his Ludlow jail and a smaller location in Springfield, he attempted to solve a previous problem where Western Mass families who committed children saw those children bussed across Massachusetts to Bridgewater or Plymouth.
Also in 2018, Gov. Charlie Baker formed a statewide commission to review the Section 35 process. A year later, state lawmakers Sen. Cindy Friedman and Rep. Ruth Balser pushed two similar bills aimed at banning the use of jails and prisons altogether for civil commitments of men. Legislators say those bills would have finished a job the state started in 2016 when it stopped sending women to jail for civil commitments.
“Everyone struggling with substance use should instead have access to programs licensed by state public health or mental health authorities, outside of prison,” Sen. Jamie Eldridge wrote in a Facebook post supporting the effort at the time.
Despite broad support, though, neither bill passed the last legislative session. One died in the Senate Committee on Health Care and Financing, while the other was discharged to the Committee on Senate Rules in August.
Balser reintroduced her legislation on Jan 26. Friedman may soon do the same in the state senate.
“Our goal is to not only bring uniformity to the law, but to treat people with [substance use disorder] as patients rather than as criminals,” Friedman wrote in a statement for this article. “We can help accomplish this goal by passing this bill.”
Back in Bridgewater, the state has moved civil commitments out of the Massachusetts Treatment Center in part due to litigation surrounding abuses there. The majority of commitments now either end up in more ideal clinical settings, the Hampden County Jail, or MASAC in Plymouth.
MASAC, meanwhile, has itself undergone changes, as Gov. Baker rolled out an increased slate of treatment options in that facility last June. That plan, though, still has civil commitment opponents bristling. They say reforms haven’t gone far enough. The move hasn’t helped problems with lack of beds either since it cut MASAC’s capacity from 251 total beds to 160, bringing the total number of beds in the Massachusetts civil commitment system down to 527.
No ideal option
As Massachusetts’ civil commitment system evolves, Doug and Lisa Johnston’s daughter is now doing well. She’s haunted by the personal and professional stigma of her addiction. But she’s in recovery, sober and pursuing jobs.
Doug and Lisa, meanwhile, are involved with Learn to Cope, the aforementioned support group for families of people with addictions. They emphasize that they speak as individuals, representing their own experiences and opinions, not those of the Learn to Cope organization as a whole.
At Learn to Cope, though, they say civil commitment frequently comes up in conversation. They’ll ask around, telling meeting attendees to raise their hands if they’ve put a loved one through a commitment.
“Most of the hands will go up,” Lisa says.
Gruesome as they sometimes are, Doug and Lisa say civil commitments can’t be replaced unless and until society tackles the structural issues that make them necessary.
Get drugs like fentanyl off the street, they say.
Decriminalize the lives of people facing addiction.
And provide better pathways to effective treatment.
Until those things happen, the Johnstons expect families will still have to go to court. And the state will have to find new places to put the people it commits.
“There’s no ideal,” Lisa says. “There is no Dana Farber [Cancer Center] for addiction. But there are things that we can do and if you have the support around you, it can help.”
This article was produced in collaboration with the Boston Institute for Nonprofit Journalism.
Dakota is a journalist working primarily with the Community Advocate. He also covers addiction and recovery in Boston through his independent project, Substantive (https://substantive.substack.com/).